Sensory Integration

Issues of Concern

Some of the postulates in Ayers’ framework have not received corroboration at the neurological level; for instance, her ideas on sensory registration and vestibular processing in ASD have not been corroborated through neuroimaging studies.[1] One of the reasons, sensory integration is not strongly validated by the current literature is because some of the available studies have not used sensory integration as stipulated by Ayers.[7] Hence, methodological variations make it challenging to interpret reported data [8]. For example, passive participation requested from the child rather than active participation.[7] Also, studies comparing sensory integration therapy to behavioral interventions have suggested the latter to be more effective in reducing the frequency of self-injurious behaviors.[8]

Clinical Significance

Sensory integration therapy (SIT) is mainly performed by occupational therapists to help children improve their processing and integration of sensory inputs to gain appropriate adaptive response to everyday stimuli.[5] During play, "the just-right challenge" is provided through sensory-motor activities.[6] ASI is commonly used to help in children's developmental, behavioral, and learning issues such as ASD, attention deficit hyperactivity disorder, developmental coordination disorders, and childhood obesity.[3][4] SIT positively affects the child's response to sensation by reducing stress, increasing adequate adaptive responses to sensory stimuli, concentrations, and social interactions.[6] SI interventions usually take place in the home, community, schools, and clinics.[7]

Sensory integration is mainly an intervention for children with developmental and behavioral disorders. The activities included in SI provide vestibular, proprioceptive, auditory, and tactile stimuli, which in turn organize the sensory system. Such stimuli are provided in play using brushes, swings, trampolines, balls, and other equipment used to elicit proprioceptive, tactile, and vestibular challenges.[5][9] Activities can also involve deep pressure, joint compression, oral moral exercises, and body massage to enhance arousal states.[3] Application of ASI requires that the sensory-motor activities target the particular areas of difficulty that interfere in the child's day to day; hence, sensory integration becomes incorporated into play. Activities usually tackle more than one sensory system at a time and trigger proprioceptors of muscles and joints, receptors in the inner ear, as well as auditory, visual, and tactile receptors on the skin.[9] Outcomes of the interventions are regularly collected, and adjustments to the intervention plan are made as needed (citation). The ultimate goal of SIT is to improve the nervous system's sensory processing, organization, integration, and motor planning.[9]

ASI interventions are founded on neuroplasticity, aiming to malleate the nervous system through experience. Guided involvement in sensorimotor activities incorporated in play can promote neuroplastic changes leading to adaptive behaviors as a result of the experiences directed during the intervention. This practice has its basis in the idea that neural networks form as a result of experience.[4] The ASI principle of neuroplasticity has been confirmed by studies that show that rodents raised in enriched environments have modifications in brain organization and conformation. Thus, demonstrating that the brain makes connections as a result of environment and learning.[4] Furthermore, a recent study by Drobnyk et al. suggests that ASI may have a positive effect on children with Rett Syndrome (RTT), improving their rate of grasping. Given that RTT is such a severely disabling condition, even small improvement may be of great benefit.[9] Practitioners of sensory integration state three categories of benefits: improved ability to focus in educational, therapeutic, and social environments, reduced inappropriate behaviors such as self-harmful behaviors, and improved neural functioning occur in activities such as language and reading.[8]

Sensory deficits are measured through the sensory profile, which consists of interviews with parents, a review of child evaluation reports, and observation of behaviors. After the assessment of data, goals are created to target areas of concern.[1][2] However, the diagnosis of sensory processing disorders is still challenging. Millet et al. classified sensory disorders into three categories and subcategories: sensory modulation disorder (overresponsive, underresponsive, and sensory seeking/craving), sensory discrimination disorder, and sensory-based motor disability (postural disorder and dyspraxia).[10]

Nursing, Allied Health, and Interprofessional Team Interventions

Sensory integration is incorporated in occupational therapy interventions that focus on directing the child towards sensory-rich experiences targeting the individual’s sensory needs. Over 95% of occupational therapists report incorporating SI in their practice.[6] The therapist adjusts the environment to produce the necessary challenges that will promote self-direction and adaptive response in motor, affective, sensory, and cognitive activities.[2] Kashefimerhr et al. reported that occupational therapy programs using SI show significant improvement in children’s modification of non-functional behaviors, communication, interaction skills, processing and motor skills, and environment adaptation.[5]